لخّصلي

Licorice (Glycyrrhiza glabra), Figure 1 is a herb that has been used for centuries in traditional medicine due to its various biological activities.Digoxin is a cardiac glycoside that works by inhibiting the sodium-potassium ATPase pump, leading to increased intracellular calcium levels and enhanced cardiac contractility.Glycyrrhizin has been found to possess several pharmacological properties, including anti-inflammatory, antiviral, antioxidant, and hepatoprotective effects However, the prolonged or excessive use of licorice, especially in the form of supplements or extracts, can lead to a condition called licorice-induced hypokalemia.Hypokalemia can potentiate the toxic effects of digoxin, as low potassium levels impair the function of the sodium-potassium ATPase pump, leading to increased intracellular sodium levels and enhanced digoxin toxicity.[1]

The mechanism by which licorice induces hypokalemia involves the inhibition of an enzyme called 11-beta-hydroxysteroid dehydrogenase type 2 (11?-HSD2).This imbalance in electrolyte levels can result in hypokalemia.[3]

Licorice (Glycyrrhiza glabra), Figure 1 is a herb that has been used for centuries in traditional medicine due to its various biological activities. The major active principle responsible for its biological activity is glycyrrhizin, which belongs to the chemical class of triterpenoid saponins.
Glycyrrhizin figure 2 is a compound composed of a triterpene backbone with a glucuronic acid moiety attached. It is the main sweet-tasting compound in licorice and is responsible for its characteristic flavor. Glycyrrhizin has been found to possess several pharmacological properties, including anti-inflammatory, antiviral, antioxidant, and hepatoprotective effects
However, the prolonged or excessive use of licorice, especially in the form of supplements or extracts, can lead to a condition called licorice-induced hypokalemia. This condition is characterized by low potassium levels in the blood, which can have serious health consequences. [1]

The mechanism by which licorice induces hypokalemia involves the inhibition of an enzyme called 11-beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2). This enzyme is responsible for converting cortisol (a hormone) to cortisone, which has minimal mineralocorticoid activity. Licorice contains glycyrrhetinic acid, a metabolite of glycyrrhizin, which inhibits 11β-HSD2. As a result, cortisol levels increase and can bind to mineralocorticoid receptors, leading to increased reabsorption of sodium and excretion of potassium in the kidneys. This imbalance in electrolyte levels can result in hypokalemia. [2]
When licorice is used concomitantly with digoxin, a medication commonly prescribed for heart conditions, the risk of hypokalemia is further increased. Digoxin is a cardiac glycoside that works by inhibiting the sodium-potassium ATPase pump, leading to increased intracellular calcium levels and enhanced cardiac contractility. Hypokalemia can potentiate the toxic effects of digoxin, as low potassium levels impair the function of the sodium-potassium ATPase pump, leading to increased intracellular sodium levels and enhanced digoxin toxicity. [3]